Publication:

Autoimmune conundrum in children with type 1 diabetes mellitus: a case series of uncommon associations

Type 1 diabetes mellitus (T1DM) is an autoimmune disorder commonly associated with other autoimmune conditions, particularly autoimmune thyroid disease and celiac disease. However, involvement of non-classical organs such as the liver, hematologic system and parathyroid glands is uncommon in children and often under-recognized. We report three pediatric cases illustrating diverse autoimmune associations with T1DM. The first case is a 9-year-old boy with T1DM who after four months of T1DM diagnosis, developed recurrent jaundice, ascites and splenomegaly and was diagnosed with biopsy-proven autoimmune hepatitis. The second case is a 7-year-old girl with chronic immune thrombocytopenic purpura (ITP) from early childhood who subsequently developed T1DM 4 years later. The third case is an 8-year-old girl with T1DM who presented after two years with hypocalcemic tetany due to autoimmune hypoparathyroidism and recurrent mucocutaneous candidiasis, suggestive of an autoimmune polyglandular syndrome type 1–like phenotype. These cases highlight the expanding spectrum of autoimmune disorders associated with pediatric T1DM beyond classical endocrine conditions. Restricting evaluation to routine screening alone may result in delayed diagnosis and increased morbidity. Clinicians should maintain a high index of suspicion for atypical autoimmune manifestations in children with T1DM to enable early diagnosis, appropriate management and improved long-term outcomes.